Parkinson's Dx Flashcards
What is Parkinson’s Dx gen char
Def: not enough dopamine in CNS
Cause: loss nigrostriatal dopamine neurons
What is Parkinson’s Dx clin
Dgx: Bradykinesia + 2 of the following: - limb muscle rigidity - resting tremor - postural instability - micrographia (writing shrinks) Lack of other neurologic impairment responsiveness to Levadopa not drug-induced
Txt goals: maintain pt independence ADL QOL alleviate symptoms minimize response flucuations limit med AE
Txt: lifestyle changes, nutrion, exercise pharm - dopamine enhancers - dopamine agonists - anticholinergics
Levodopa/Carbidopa (Sinemet)
Class: Dopamine Enhancement
MOA: increase dopamine CNS
Amantadine (Symmetrel)
Class: Dopamine Enhancement
MOA: block glutamate transmission
AE: sedation, rebound PD
Dopamine Enhancement AE
Agitation Confusion Insomnia Psychosis HA Dizziness Orthostasis Dyskinesias N/V
MAO-B inhibitors
Class: Dopamine Enhancement Drugs: Rasagiline/Selegiline MOA: prevent DA breakdown CI: TCA, SSRI, SNRI, meperidine MAOI dried, aged, fermented foods
COMT inhibitors
Class: Dopamine Enhancement
Drugs: Entacapone & Tolcapone
MOA: inhibit breakdown of levodopa and increase its 1/2 life by 50%
Dopamine Agonists AE
Confusion Dizziness Orthostasis Nausea Hallucinations Asthenia Syncope Peripheral edema
Dopamine Agonists
Drugs: Pramipexole
AE: suddenly falling asleep
What are CNS effects of excess dopamine
confusion
hallucinations
What are Systemic effects of excess dopamine
GI complaints
Orthostatic hypoTN
Who is at higher risk of addictive behaviors with Dopamine Agonists
- Male
- Younger age at PD onset
- impulsivity traits and premorbid impulse disorder
depression and history of alcohol/substance abuse
Anticholinergics
Drugs: Benztropine MOA: decrease cholinergic activity to decrease tremors AE: Confusion Memory loss Anti-SLUD sedation depression orthostasis drowsiness
